Musculoskeletal 3

What is the efficacy of modalities and splinting in plantar heel pain?
• Limited evidence that stretching exercises and heel pads associated with better outcome than orthoses for people who stand > 8 hrs/day
• Limited evidence that topical steroids with iontophoresis would be helpful
• Limited evidence that dorsiflexion night splints reduce heel pain
• For plantar fasciitis, study showed non-WB stretching of plantar fascia better than WB stretching of Achilles --> prefabricated soft insoles and 3 weeks of NSAIDs also helpful

What is the utility of soft cervical collar and modalities for neck pain following rear-end auto collision?
• Recent study showed no utility of soft collar for pain, ROM, ADLs
• People with soft collar took longer to return to work than those treated with early mobilization
• Lack of evidence for: thermotherapy, massage, EMG biofeedback, mech cervical traction, US, e-stim

What is the utility of counterforce bracing, modalities, and exercise in a secretary with lateral epicondylitis?
• Counterforce brace: nonelastic strap curved for better fit and support of forearm, decreases muscle force on lat epicondyle --> mixed evidence for splinting
• Isotonic eccentric exercise program found to be more effective than stretching program
• Lack of evidence for modalities
• 83% of cases improved overall --> poor improvement assoc with manual jobs, high baseline pain, neuropathic sx, keyboarding, highly repetitive monotonous work

What is the utility of bracing, modalities, and exercise in assembly worker with CTS?
• Mod effectiveness for short term oral steroids
• Limited evidence for US, yoga, carpal bone mobilization
• Benefit seen from 6 weeks of nocturnal splinting, greater benefit when splints worn full time

What is the utility of lumbosacral supports and directional-based exercises for LBP?
• Moderate evidence that LS support is ineffective for primary LBP
• No evidence that support useful for secondary LBP prevention
• RCT showed McKenzie method and intensive dynamic strength training equally effective
• Study showed that patients who received direction-specific exercises (in those who had a directional preference identified) had greater improvement than non-direction-specific

What is the evidence for modalities and exercise for Achilles tendonosis?
• Weak evidence of benefit from oral NSAIDs
• Weak or no evidence for heel pads, topical laser therapy, heparin, steroid injection, modalities
• Eccentrically loading the Achilles tendon via calf muscle training is a well-supported treatment